Principles of Osteopathy
Dain L. Tasker, D. O.
CHAPTER IV - Spinal Hyperaesthesia and Muscular Tension
Osteopaths are not the first or only physicians who have
used the spine as a means of diagnosis as well as an area upon which to concentrate
therapeutic methods. It is interesting and instructive to note the steps
in the development of the knowledge of spinal conditions and of the indica-tions
of remote functional disturbances which are registered there.
Subjective Symptoms. - Subjective symptoms
precede any attempt to discover objective evidences of disease. It
was early noted by physicians that patients could not be re-lied upon to
interpret their own symptoms. This led to efforts to discover symptoms
which were independent of the patient's imperfect perceptions. Palpation
would naturally be used at the areas complained of by the patient.
Since the brain takes cognizance of only the peripheral areas of distribution
of sensory nerves, instead of the whole course of the nerve fibers, the
physician might still be misled in applying palpation, because he would
be largely governed by the patient's sensory impressions. Palpation
made with reference to a realizing sense of the distribution and function
of the nervous system, becomes a more satisfactory means of diagnosis.
As the knowledge of the nervous system increased, attention was called
more and more to the spinal column, on account of its relations to the
great nervous mass within it. Palpation of the spinal column demonstrated
the existence of sensitive areas, associated with visceral or other disorders;
therefore, hyperaesthetic areas are the first diagnostic points mentioned
in medical literature, in regard to the spinal lesions Such hyperaesthetic
areas were considered as evidence of spinal irritation; that is, irritation
of the spinal cord.
Irritation of the Spinal Nerves. - The first
reference to spinal irritation which I have found is contained in a monograph
entitled "A Treatise on Neurologic Diseases Dependent on Irritation of
the Spinal Marrow and Ganglia of the Sympathetic Nerve," by Thomas Pridgin
Teale, 1834. He quotes a letter from Mr. R. P. Player to the editor
of the Quarterly Journal of Science "On Irritation of the Spinal Nerves,"
dated December 10, 1821, as follows: "I take the liberty to submit to your
notice a pathological fact which has not, to the best of my knowledge,
been generally remarked and attention to which, so far as my own experience
goes, promises some diminution of those difficulties with which the healing
art has to contend. Most medical practitioners who have attended
to the subject of spinal disease, must have observed that its symptoms
frequently resemble various and dissimilar maladies and that commonly every
function of every organ is impaired whose nerves originate near the seat
of the disorder. The occurrence of pain in distant parts forcibly
attracted my attention and induced frequent examinations of the spinal
column; and after some years' attention, 1 considered myself enabled to
state that in a great number of diseases morbid symptoms may be discovered
about the origins of the nerves which proceed to the affected parts, or
of the spinal branches which unite; and that if the spine be examined,
more or less pain will commonly be felt by the patient on the application
of pressure about or between those vertebrae from which such nerves emerge.
Spinal Treatment. - "This spinal affection
may, perhaps, be considered as the consequence of diseases, but of its
existence at their commencement any one may satisfy himself; and this circumstance,
combined with the success which has attended the employment of topical
applications to the tender parts about the vertebrae, appears to indicate
that the cause may exist there. Prejudice sometimes operates against
ideas of connection so remote; but in many instances patients are surprised
at the discovery of tenderness in a part, of whose implication and disease
they had not the least suspicion."
Control of the Body by the Nervous System.
- Dr. Teale brings to his aid in the exposition of his subject, some interesting
corroboratory observations made by others and recorded in the medical literature
of that period. He quotes Dr. Darwell in an interesting paragraph
which is a faint distant undercurrent of Dr. A. T. Still's oft-repeated
statement concerning the interaction of nerves and the blood stream.
The passage is as follows: "If, however, the nervous system is more or
less connected with every function of the animal body; if the circulation
of the blood, the phenomena of the respiration and the operation of intellect,
cannot be carried on without its intervention, the manner in which it is
disregarded can not but be a most important defect. It has perhaps
in great measure arisen from always contemplating the brain as acted upon
by the circulation and never reversing the order of review."
A Concept of the Nervous System. - One of
the best expressed concepts of the nervous system I have read, is Dr. Teale's
introduction to his monograph. It is the concept which is being more
clearly taught in osteopathic colleges than in those of other schools of
medicine: "The term Neuralgia which was originally employed to designate
certain affections of nerves attended with severe pain has of late with
great propriety been extended from its original and literal signification,
to many other morbid affections of nerves, which are not characterized
by pain, but by some other perverted state of their functions."
Neuralgia. - "Neuralgia includes within its
range a great variety of diseases, presenting an endless diversity both
in their symptoms and in the parts where they are seated. That such
variety should exist, ceases to excite surprise, when we consider how varied
are the functions of the different nerves and how diversified the tissues
and organs to which they are distributed.
"To the attentive observer of diseases, neuralgic
affections, under the more extended signification, must repeatedly present
themselves. The skin, for instance, may be the seat of every degree
of exalted or diminished sensibility, from the slightest uneasiness to
the most acute suffering and from the most trivial diminution of sensibility
to the complete obliteration of feeling, - symptoms not dependent upon
disease affecting the different tissues of the part but solely referable
to a morbid condition of the sentient nerves. The voluntary muscles
may in like manner indicate in a variety of ways a morbid condition of
the nerves with which they are supplied. They may be affected with
weakness, spasms, tremors, or a variety of other disordered states included
within the two extremes of convulsion and paralysis. The involuntary
muscles may have the harmony of their actions interrupted from a morbid
condition of their nerves; the heart may be affected with palpitation;
the vermicular motion of the stomach or the peristaltic action of the intestines
may be subject to irregularity. The sensibility of the internal organs
may like-wise be affected, the heart, the stomach, the intestines, being
the seat of pain, referable to their nerves, and independent of inflammation,
or any alteration of structure. The secretions may also undergo alterations,
both in quantity and quality, from a perverted agency of the nerves upon
which they depend. Such is a very imperfect recital of the various
morbid affections which may be included under the term Neuralgia, and so
frequent is their occurrence that they must be familiar to every practitioner.
They are, however, often perplexing in their treatment and not unfrequently
exhaust the patience of the afflicted sufferer, and also of the medical
"The difficulty and embarrassment which have attended
the diagnosis and treatment of these affections, I am inclined to believe,
has principally arisen from mistaken views of their pathology. They
have too often been regarded as actual diseases of those nervous filaments
which are the immediate seat of the neuralgia instead of being considered
as symptomatic of disease in the larger nervous masses from which those
filaments are derived; hence the treatment has too frequently been ineffectually
applied to the seat of neuralgia ; instead of being directed to the more
remote and less obvious seat of disease.
"It is now pretty generally admitted as a pathological
axiom, that disease of the larger nervous masses, as the brain and spinal
marrow, is not so much evinced by phenomena in the immediate seat of disease,
as in those more remote parts to which the nerves arising from the diseased
portion are distributed. In the more severe forms of disease, this
principle is readily admitted and recognized. When for instance one-half
of the body shall have lost its sensibility and the corresponding muscles
their power of action, the skin and the muscles are not regarded as the
seat of disease, but the brain is immediately referred to. In the
slightest forms of disease of the brain and spinal marrow, such as do not
completely obliterate but merely impair or pervert the functions of the
nerves - such as do not paralyze the sentient and muscular powers of the
part but produce weakness, tremors, spasms, etc., ill the muscular system,
and numbness and prickings, pains and other morbid feelings in the nerves
of sensation, this important principle, which as strictly obtains as in
the former instance, is too often entirely overlooked; and a numerous class
of complaints of very frequent occurrence, are regarded as nervous or spasmodic
diseases of the part affected, instead of being considered as actual diseases
of that portion of the brain and spinal marrow from which the nerves of
the part are derived.
Visceral Disturbance Due to Disturbed Nerve Control.
- "The same pathological principle is, I believe, equally applicable to
the sympathetic system of nerves; although it may be difficult to establish
this opinion by actual experiment, yet I think it may be rested upon a
well grounded analogy, which will justify us in regarding the nervous masses
of the ganglionic system as bearing the same relation to the nerves derived
from them, as the large nervous masses of the cerebro-spinal system bear
to their respective nerves. Hence many nervous affections of the
viscera ought not be considered as diseases of the viscera themselves but
as symptomatic of disease in those particular ganglia whence their nerves
Co-existence of Spinal Tenderness. - "Influenced
by such considerations, I have for a few years been in the habit of treating
many of these nervous affections as diseases of some portion of the spinal
marrow or ganglia; and leave been still further confirmed in my opinion
by the frequent and almost uniform coexistence of tenderness on pressing
some portion of the vertebral column and the circumstances of the tender
portion of the spine being in a particular situation where the nerves of
the affected part originate.
Symptoms of Spinal Irritation. - "The symptoms
of spinal irritation consist in an infinite variety of morbid functions
of the nerves of sensation and volition which have their origin in the
spinal marrow, and the parts in which these morbid functions are exhibited,
of course, bear reference to the distribution of the spinal nerves.
"The morbid states of sensation include every variety,
from the slightest deviation from the healthy sensibility of any part,
to the most painful neuralgic affections oil the one hand, and to complete
numbness or loss of feeling on the other; including pains which may be
fixed or fugitive or darting in the direction of the nerve, pricking and
tingling sensations, a sense of creeping in the skin, of cold water trickling
over it, and numerous other states of perverted sensation of which words
are inadequate to convey a description. In the muscular system we
find weakness or loss of power, tremors, spasms or cramps and sometimes
a tendency to rigidity.
"These symptoms sometimes exist in so slight a degree
that the patient considers them unworthy of notice, and only admits their
existence when particular inquiry is made respecting them; the only complaint
which he makes being of an unaccountable sense of weakness and inability
of exertion. In other cases the tremors have excited alarm; sometimes
the neuralgic pains in the scalp or the fixed pain in the muscles, particularly
when it occurs in the intercostal muscles, have suggested the idea of serious
disease in the brain or in the lungs; and when the pain is seated in the
muscles of the abdomen, a fear that some organic disease of the abdominal
viscera has taken place harasses the mind of the patient. The muscular
weakness in some cases lending to paralysis often suggests the fear of
apoplexy or paralysis from cerebral disease.
Duration of Affections Due to Spinal Irritation.
- "The affection is often of very protracted duration, undergoing alternate
variations from the sanative powers of the constitution and the different
existing causes of disease. There are many individuals in whom the
complaint has existed, in varying degrees of intensity for a series of
years, without its real nature having been suspected; the patients and
their medical attendants having regarded it throughout as a rheumatic or
a nervous affection.
"In this complaint tenderness in the vertebral column
which corresponds to the origin of the affected nerves, is generally in
a striking and unequivocal manner evinced by pressure. In some instances
the tenderness is so great that even slight pressure can scarcely be borne,
and will often cause pain to strike from the spine to the seat of spasm
"This affection of the spinal marrow occasionally
exists throughout its whole extent; more frequently, however, it is confined
to some particular portion, and occasionally is seated in different and
remote portions at the same time; the particular symptoms and tenderness
on pressure indicating the affected part.
"The symptoms of course vary considerably, according
to the particular part of the spine which is affected, and bear reference
to the distribution of the different spinal nerves.
Affections of the Upper Cervical Region. -
"When the upper cervical portion of the spinal marrow is diseased, we frequently
find neuralgic affections of the scalp; the pain strikes in various directions
over the posterior aid lateral parts of the head; sometimes the twigs in
the neighborhood of the ear, sometimes those which ascend over the occiput
to the superior part of the scalp, are more particularly the seat of the
complaint; the nervous twigs distributed to the integuments of the neck
are occasionally affected, the pain darting across the neck to the edge
of the lower jaw, and sometimes encroaching a little upon the face.
These neuralgic diseases frequently assume an intermittent form, the paroxysms
generally occurring in the evening. A stiff neck or impaired action
of the muscles moving the head frequently attend the affection of the upper
cervical portion of the spinal marrow; and occasionally the voice is cornpletely
lost, or suffers alternation, and the act of speaking is attended with
pain or difficulty.
Irritation of the Lower Cervical Region. -
"Irritation of the lower cervical portion of the spinal marrow gives rise
to a morbid state of the nerves of the upper extremities, shoulders, and
integuments at the upper part of the thorax. Pains are felt in various
parts of the arm, shoulder, and breast; sometimes the pain takes the course
of the anterior thoracic branches of the brachial plexus, occasionally
the pain is fixed at some point near the clavicle, scapula or shoulder
joint at the insertion of the deltoid, or near the elbow or shoots along
the course of some of the cutaneous nerves. Frequently one or both
of the mammae become exquisitely sensible and painful on pressure, and
some degree of swelling occasionally takes place in the breast, attended
with a knotty and irregular feeling, when the neuralgic pains have existed
a considerable time in the that part, prickling and numbness are often
felt in the upper extremities; and also a sensation of cold water trickling
over the surface. On rubbing the hands over the part affected a soreness
is frequently felt, which is described as not merely situated in the integuments
but also in the more deep seated parts. In the muscular system are
observed most frequently a weakness of the upper extremities sometimes
referred particularly to the wrists, tremors and unsteadiness of the hands;
also cramps and spasms of various degrees of intensity. Occasionally
there is an inability to perform complete extension of the elbows, the
arm appearing restrained by the tendon of the biceps; and tightness being
produced in this part when extension is attempted beyond a certain point.
As far as I have observed, the pain and other morbid feelings in the upper
extremities and chest are felt more frequently and more severely oil the
left than on the right side.
"Females of sedentary habits appear particularly
subject to these affections of the upper extremities, and it is not uncommon
for them to complain of being scarcely able to feel the needle when it
is held in their fingers, and that their needles and work frequently drop
from their hands.
Irritation in the Upper Dorsal Region. - "When
the upper dorsal portion is affected, in addition to various morbid sensations
similar to those in the extremities, there is often a fixed pain in some
part of the intercostal muscles, to which the name pleurodynia has been
assigned; and when this pain has existed a long time, there is tenderness
on pressing the part.
Irritation in the Lower Dorsal Region. - "When
the lower dorsal half of the spinal marrow is the seat of irritation, or
subacute inflammation, the pleurodynia, when it exists, is felt in the
lower intercostal muscles; frequently there is also a sensation of a cord
tied round the waist; and oppressive sense of tightness across the epigastrium
and lower sternal region; and soreness along the cartilages of the lower
ribs or in the course of insertion of the diaphragm. Various pains,
fixed and fugitive, are also felt in the parietes of the abdomen, throughout
any part of the abdominal and lumbar muscles; the pain is frequently fixed
in some portion of the rectus muscle and not infrequently in the oblique
muscle or transversalis, a little above the crest of the ilium, particularly
when the origin of two or three of the lowest dorsal nerves is diseased.
Irritation in the Lumbar and Sacral Regions.
- "The affection of the lumber and sacral portion of the spinal cord often
produces a sensation of soreness in the scrotum and neighboring integuments;
and the lower extremities become the seat of various morbid sensations,
spasms, tremors, etc., for the most part resembling those which have been
described as occurring in the upper limbs. The patients also complain
of a sense of insecurity or instability in walking; their knees totter,
and feel scarcely able to support the weight of the body.
The Effect of Recumbency. - "In some cases
very considerable relief is found from recumbency,, the pain frequently
being diminished as soon as the patient retires to bed, independently of
any paroxysmal remission.
Irritation of Spinal Marrow Not Necessarily Dependent
on Disease of Vertebrae. - "This irritation or subacute inflammatory
state of the spinal marrow is not necessarily connected with any deformity
of the spine, or disease in the vertebrae. It may co-exist with these
as well as with any other diseases, but it so repeatedly occurs without
them that they can not be regarded as dependent upon each other.
Where, however, inflammation and ulceration of the vertebrae or intervertebral
cartilages exist, it is probable they may predispose to, and in some instances,
act as an exciting cause of an inflammatory state of the nervous structures
which they contain; for we not frequently find inflammatory affections
of the vertebrae in conjunction with symptoms of irritation of the spinal
marrow. But these two affections, although coexisting, bear no regular
relations to each other; and during the progress of the vertebral disease
the affection of the nervous structures is subject to great changes and
fluctuations. The local remedies employed for arresting the disease
in the bone often alleviate the affection of the spinal marrow at the very
commencement of the treatment, long before the vertebral disease is suspended;
but as the neighboring inflammation in the bones appears to predispose
or excite the nervous mass which they contain to disease, relapses of the
nervous affections are repeatedly occurring during the whole course of
Lateral Curvature. - "The affections of the
spine, termed lateral curvature and excurvation, appear to have no necessary
connection with the disease which I have been describing; and the proportion
of cases in which they are found united is so small that lateral curvature
can scarcely be considered even as predisposing to this disease.
The most extreme degrees of deformity are frequently observed without any
affection of the nerves; and when lateral curvature does occasionally co-exist,
local antiflogistic treatment will often speedily remove the nervous symptoms
while the curvature remains unrelieved. Hence there is an impropriety
in considering these nervous symptoms as a result of the deformity and
in explaining them upon the mechanical principle of pressure and stretching,
to which the nerves are supposed to be subjected as they issue from the
intervertebral foramina. If the pressure and stretching produced
by the curvature were the cause of the nervous symptoms, they ought to
continue as long as the deformity remains.
Treatment. - "When the different neuralgic
symptoms which have been enumerated can be traced to this morbid state
of some portion of the spinal marrow, the treatment that ought to be pursued
is readily decided upon. Local depletion by leeches or cuping, and
counter irritation by blisters to the affected portion of the spine, are
the principal remedies. A great number of the cases will frequently
yield to the single application of any of these means. Some cases
which have even existed several months I have seen perfectly relieved by
the single application of a blister to the spine, although the local pains
have been ineffectually treated by a variety of remedies for a great length
of time. A repetition of the local depletion and blistering is, however,
often necessary after the lapse of a few days, and sometimes is required
at intervals for a considerable length of time. In a few very obstinate
cases issues or setons leave been thought necessary; and where the disease
has been very unyielding, a mild mercurial course has appeared beneficial.
"When my attention was first directed to this subject,
I considered recumbency a necessary part of the treatment; it is, for a
moderate length of time, undoubtedly beneficial and frequently very much
accelerates recovery, but subsequent observation has convinced me that
it is by no means essential. I have seen several instances of the
most severe forms of those complaints occurring in the poorer classes of
society, where continued recumbency was impracticable, which have, nevertheless,
yielded without difficulty to the other means of the treatment, whilst
the individuals were pursuing their laborious avocations.
"These observations, however, arc not intended to
apply to those cases in which there is actual disease of the vertebrae.
"When there exists a tendency to relapse, I have
thought it advantageous to continue the use of some stimulating liniment
to the spine for a few weeks after the other means of treatment have been
discontinued. A liniment consisting of one part spirits of turpentine
and two of olive oil is what has generally been employed.
Ganglia of the Sympathetic Nerves. - "The
ganglia of the sympathetic nerves appear subject to a state of disease
which have been described in the preceding chapter, as occurring in the
"As the disease may be confined to one part of the
spinal marrow, or exist simultaneously in different portions, or may even
pervade its whole extent, so the affection of ganglia may be confined to
one of these nervous masses, may exist in several which are contiguous,
or in ganglia remote from each other; and as there is reason to believe
the whole chain may occasionally be affected.
"The disease of the ganglia is seldom found, except
in conjunction with that of the corresponding portion of the spinal marrow,
whereas the spinal marrow is often affected without the neighboring ganglia
being under the influence of disease. Thus we frequently find symptoms
of disease in a portion of the spinal marrow without any evidence of its
existence in the corresponding ganglia, frequently the symptoms of both
combined, and occasionally, but rarely, symptoms referable to the ganglia
without spinal marrow being implicated.
Symptoms of Irritation of Sympathetic Ganglia.
- "The principal symptoms resulting from irritation of the ganglia of the
sympathetic are to be found in those organs which derive their nerves from
this source. They consist of perverted functions of these organs,
and are exemplified by a variety of phenomena. The involuntary muscles,
deriving their power from the sympathetic, have their action altered as
is evinced by spasms and irregularity in their contractions. The
heart is seized with palpitations, the large vessels with inordinate pulsations;
the muscular fibers connecting with the bronchial apparatus are thrown
into spasms, constituting a genuine asthma independent of bronchial inflammation.
The muscular fibers of the stomach and intestines become the seat of spasms
and various other deviations from their natural operation. The sensibility
of the organs, which derive their sentient power from the great sympathetic,
is variously perverted, the nervous filaments being the seat of pain.
The heart and lungs, for instance, are subject to morbid sensations bearing
great analogy to those which have been designated 'tic douloureax'
when occurring in the spinal nerves. The stomach and intestines are
liable to similar neuralgia, to which the names gastrodyma and enterodyma
have been applied. The kidneys, the bladder, and the uterus are liable
to the same perverted state of their sensibility. The secretions
also undergo alterations, products being formed, which in health have no
existence. This is exemplified by the enormous secretions of air
which sometimes occur in the stomach. Large quantities of clear transparent
liquid are also secreted by this organ, constituting what is called pyrosis.
The secretions of the stomach undergo variation in their quantities, rendering
them unfit for digestive process. It is probable that the secretion
of the liver also experiences some alteration in these complaints.
The urine is sometimes influenced, and I am inclined to suspect that some
forms of diabetes partake of neuralgic character. Leucorrhea is frequently
a concomitant of these diseases, and ceases on their removal; but I am
not prepared to say that it is ever symptomatic of them. Irregularities
in the catamenia are often observed, the discharge often being generally,
Middle and Lower Thoracic Sympathetic Ganglia.
- "The ganglia most liable to the disease are the middle and lower thoracic,
from which the splanchnic nerves are derived, giving rise to various disorders
of the stomach and digestive organs, which will hereafter be more fully
discussed. Next in frequency is the affection of the cervical ganglia,
producing painful and spasmodic states of the heart. The symptoms
denoting disease of other ganglia, although occasionally met with, are
less frequent in their occurrence. Irritability of temper and depression
of spirits often attend these complaints, particularly when the stomach
is the part which suffers.
"The disease of the ganglia, like that of the spinal
marrow, is not necessarily connected with disease of the vertebrae or distortion
of the spine. It may co-exist with these complaints, and, when it
does so, the symptoms proper to the ganglionic disease are often erroneously
supposed to be produced by distortion or by disease of the vertebrae; they
are, however, frequently relieved by treatment, whilst the disease of the
bones remains uninfluenced by it, and the most extreme distortion of the
spine or destruction of the vertebrae from inflammation may exist without
there being any symptoms attributable to neuralgia of the sympathetic nerves.
"In conjunction with the symptoms denoting disease
of the ganglia, tenderness to a greater or less degree may generally be
found on pressing some part of the spine, and the tender portion invariably
corresponds with the symptoms; or rather, the seat of tenderness is near
the part occupied by the particular ganglia from which the nerves of the
disordered organ are derived; for example, when the heart is affected the
tenderness is found in some of the cervical vertebrae, and when the stomach
is the seat of complaint, it is in some of the middle or lower dorsal vertebrae.
Spinal Treatment. Hyperaemia. - "With
respect to the treatment, I have but little to add to what has been said
in the preceding chapter respecting the treatment of irritation of the
spinal marrow. Leeches, culping, blisters, etc., to the neighborhood of
the affected ganglia constitute the essential part."
Muscular Tension. - Following the observation
of spinal tenderness came the noting of muscular tension accompanying it.
As near as I can determine from perusing medical literature, muscular tension
was not recognized until after the advent of Osteopathy. Since the
attention of medical writers was called to the conditions of the spinal
column called "lesions" there are frequent passages descriptive of these
in medical literature. One of the best of these references is found
in Boardman Reed's work on "Diseases of the Stomach and Intestines," and
is as follows:
"Dr. John P. Arnold has recently called attention
to novel objective sign which may be recognized upon palpation over the
sensitive regions along side of the spinal vertebrae, and sometimes in
such regions which are not sensitive to pressure, though in all cases he
maintains that the part of the body supplied by the vasomotor nerve fibres
immerging in the corresponding intervertebral space will be found to present
some abnormal condition. The peculiarity described by him is, in
such cases, a somewhat doughy, and in chronic ones, a gristly tense, cord
like feeling of the band of longitudinal muscular fibres which run up and
down on either side of the spine. This abnormality is supposed by
Arnold to be due to a contested or infiltrated condition of the muscle
while the cord itself is anemic, probably in chronic cases. Hammond
believed the spinal cord to be anemic in such cases. The findings
obtained by a careful palpation over the spine should thus assist in directmg
our attention to the organ or part of the body which may be suspected of
Digital Examination of the Spinal Area. -
"You should make it a rule to examine carefully the spines of all chronic
invalids by pressing deeply with the finger tips (or with the thumbs, as
Flint advised) close to the vertebrae and then exert gentle traction in
a lateral direction outward from the spine on either side. The patient
should be lying upon his right side while you palpate all along the left
side of the vertebrae, and should then change to his left side in order
that you may palpate upon the right side of the latter so that the tissues
may be in the utmost condition of relaxation practicable. In both
cases you will find it best to stand in front of the patient and reach
over his upper side to make palpation along the region of the upper side
of the spinal column.
"In numerous patients, especially those suffering
from digestive derangements, you will be likely while palpating in the
way described to recognize in the longitudinal muscles running parallel
and close to the spine the tense, cord-like sensation above mentioned.
If, simultaneously with your recognition of such a condition the patient
complains of sensitiveness in the same regions, the accuracy of your finding
will be at once confirmed."
The Use of Spinal Muscular Tension in Diagnosis.
- The use of these tense cord-like muscles as diagnostic evidences of disease
has been a constant practice of Osteopaths from the beginning of Dr. Still's
work. Judging from the quotation the true significance of these contractions
has not been apprehended by the medical profession in general. It
is very evident that a contracted muscle is shorter and thicker than when
relaxed, also that when contracted it exerts force to draw its extremities
together. The ends of the muscle being attached to bones forming
portions of a movable articulation, a change in the relation of the bones
must follow. This change is called a subluxation and is described
more in detail in another chapter.
Cause or Effect? - Having noted that sensitiveness
and muscular contraction are well recognized conditions found along the
spinal column, the question arises, are these merely objective symptoms
of disease or are they to a large extent causative factors in the origin
and maintenance of diseased conditions of the areas of peripheral distribution
of spinal nerves? Are they causes or effects?
They have been noted almost exclusively as efficient causes
of disease. Furthermore, osteopathic therapeutics have been administered
from that standpoint with marked success. This change in position and
size of tissues is recognized as an obstruction to the movements of fluids,
and therefore is a condition operating in the system to cause disease.